How to get the most for your health insurance dollar

With an increasing number of Americans assuming a greater share of their health care costs, getting the most value for your health insurance dollars is more critical than ever.

"This is a new day for health insurance," says Vicki Breitbart, director of the Health Advocacy Program at Sarah Lawrence College. "The Affordable Care Act increases our rights as consumers of health care. Being an informed consumer is the best way to get the most from your plan."

Unlike in the past, consumers are now "guaranteed to get a health insurance plan that has real value" because insurers must cover yearly wellness visits, health screenings and other essential health benefits, says Christine Barber, senior policy analyst for Community Catalyst.

"For years, health insurance plans could offer bare-bone benefits and a huge deductible," says Barber. "People would run out of coverage and be left underinsured with medical debt."

To find the best value, experts advise consumers to begin by assessing their health care needs. Do you have a chronic illness that calls for frequent doctor visits and multiple medications? Do you have a child with special needs who requires ongoing therapy? "It's important to get the health plan that works best for you and your family," says Barber.

Once you fully understand your health care needs, it's time to shop for insurance.

According to Susan Pisano, spokesperson for America's Health Insurance Plans, four factors come into play when determining the value of a policy: the cost of the annual premium, the type of benefits offered, the out-of-pocket expenses and your eligibility for tax credits and subsidies in the new health insurance marketplaces created by the Affordable Care Act.

"Consumers can easily make these comparisons by reviewing the summary of benefits and coverage provided by insurers," she said.

Even "catastrophic" health plans -- available to people under age 30 and to some individuals with limited incomes -- provide value by protecting you from worst-case scenarios. Although catastrophic plans come with lower premiums and higher out-of-pocket costs, they still cover essential health benefits, including three primary care visits per year and preventive services such as annual wellness visits, immunizations and certain health screenings at no additional cost.

Check out the new marketplaces

Sally McCarty, a senior research fellow at Georgetown University's Center on Health Insurance Reforms, urges consumers to explore the state-based marketplaces (sometimes called "exchanges") that will begin selling plans in October with coverage effective Jan. 1, 2014. Consumers with incomes up to 400 percent of the federal poverty level ($45,960 for individuals and $94,200 for a family of four in 2013) can get tax credits toward premium costs. Those with incomes up to 250 percent of the federal poverty level ($28,725 for individuals and $58,875 for a family of four in 2013) can get subsidies for out-of-pocket expenses.

"There certainly is an effort in some states to scare people away from the [new marketplaces]. You hear a lot of horror stories about the cost of premiums," says McCarty. Yet one study by the Urban Institute concluded the marketplaces would offer robust competition leading to reasonably priced premiums. "That's why it's crucial for people to check it out for themselves."

To get the facts, visit the federal government's website at HealthCare.gov for information about the health insurance marketplace in your state. Spanish-speaking consumers can visit CuidadoDeSalud.org. Certified "navigators" fluent in hundreds of languages will be on hand beginning in October to help consumers review their options and enroll in a plan.

Save on prescription drugs

The cost of prescription drugs can account for a big chunk of out-of-pocket expenses, especially if you're managing a chronic illness such as asthma, diabetes, high blood pressure or arthritis. Americans spent about $325 billion on prescription drugs in 2012.

Fortunately, there are a number of ways to slash the costs for prescription drugs. Speak with your doctor about using a generic drug rather than the brand-name version. The cost of a generic drug is 80 percent to 85 percent lower, on average, than brand-name products, according to the U.S. Food and Drug Administration. You can also ask your doctor for medication samples.

Compare prices at pharmacies in retail stores (such as Target, CVS and Walmart), wholesalers (such as Costco), online and via mail order. Discounts often apply when ordering a 30- or 90-day supply of medications. Prescription coupons are available at OptimizeRx.com and InternetDrugCoupons.com.

You may qualify to take part in patient assistance programs that offer prescription discounts to people with limited income. Visit the pharmaceutical company's website or check out RXAssist.org and NeedyMeds.org for information about assistance programs. AARP has a program that offers savings of up to 30 percent off prescription drugs.

Compare health care costs among providers

To the extent possible, compare actual prices for health care services and procedures to keep your out-of-pocket expenses to a minimum. The cost for the same medical service can vary by tens of thousands of dollars from one provider to another, according to a U.S. Centers for Medicare & Medicaid Services report detailing what hospitals charge Medicare.

"The cost of every health care service matters because it's coming out of consumer's pockets," says Francois de Brantes, executive director of the Health Care Incentive Improvement Institute, which partnered with Catalyst for Payment Reform to publish the "Report Card on State Price Transparency Laws." Some states, such as Massachusetts and New Hampshire, have All-Payer Claims Databases that collect and aggregate claims from commercial and public insurers to offer consumers true pricing information. Other states aren't as forthcoming.

An ounce of prevention is worth a pound of cure

Experts advise consumers to take advantage of the wellness and preventive services -- from annual checkups and childhood vaccinations to cancer screenings and more -- that are now available at no extra cost since passage of the Affordable Care Act.

"Staying healthy is one of the really good ways to save your health care dollars. It's better to get an immunization than to be hospitalized with the flu," says Pisano. "That's both smart from the perspective of dollars and cents and smart from the perspective of your health."